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BRAIN AND SPINE INSTATE FOR CHILDREN NPI 1104166735


NPI Information

NPI: 1104166735
Provider Name: BRAIN AND SPINE INSTATE FOR CHILDREN

Doing Business As: BASIC

Classification: Preferred Provider Organization - 305R00000X
Entity Type: Organization
Address:
2813 S HIAWASSEE RD
SUITE 201
ORLANDO, FL
ZIP 32835
Phone: (407) 378-5100
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BRAIN AND SPINE INSTATE FOR CHILDREN is a preferred provider organization in Orlando, FL. The provider is a group of physicians and/or hospitals who contract with an employer to provide services to their employees. In a PPO, the patient may got to the physician of his/her choice, even if that physician does not participate in the PPO, but the patient receives care at a lower benefit level. BRAIN AND SPINE INSTATE FOR CHILDREN NPI is 1104166735. The provider is registered as an organization entity type.
The provider Is Doing Business As Basic.

The provider's business location address is:

2813 S HIAWASSEE RD
SUITE 201
ORLANDO, FL
ZIP 32835-300
Phone: (407) 378-5100

The provider's authorized official is Keyne K Johnson .
The authorized official title is Medical Director and has the following contact phone number (407) 378-5100.

The enumeration date for this NPI number is 2/19/2013 and was last updated on 2/19/2013.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1305R00000XPreferred Provider OrganizationME 102412FLORIDAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1000384900MEDICAIDFLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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